The latest polling on Obamacare is the worst it has ever been, with majorities of Americans saying they expect their family will be worse off under it and majorities saying it would be better to go back to the pre-Obamacare health care system. A Fox News poll found only 26 percent of voters say their health care situation will be better under the new law, while twice as many – 53 percent – say they expect it will be worse. Only 34 percent of those polled want to stick with Obamacare. There is even more evidence in this new poll from The Morning Consult, which finds even Democrats dislike the now-constitutional individual mandate, and no signs of any enthusiasm for the new health insurance regime.

Organizing for Action (OFA), the shadowy nonprofit activist group that evolved from the president’s campaign, is stepping up its defense of his controversial health care law, signaling to some that the group is increasingly worried about a political backlash against the law.

OFA announced a seven-figure ad buy on Monday for a 30-second spot touting the law’s supposed benefits. It also rolled out an activist program called “Team Obamacare” to “stand up to the conservative attacks, and tell the story of how Obamacare is working.”

The effort comes in the midst of news that Obamacare, as the Affordable Care Act is commonly known, will significantly raise insurance premiums in some states, and may increase rates for many hourly wage-earners.

Implementation of the law has proved a headache for the administration. Even some of the law’s most strident supporters have said that it is “just beyond comprehension” and could be a “train wreck” if it is not implemented correctly.

Problems with implementation and the law’s apparent failure to bring down insurance premiums, as its supporters routinely said it would, have Republicans convinced that their opposition to the law will be a political winner in next year’s midterm elections.

While premiums will go up equally for men and women in California, women should benefit more from Obamacare’s subsidies. That’s because 40-year-old women have lower average incomes than men do. According to the Census, in 2011 the median income for 35-to-44 year olds was $36,724; however, for men it was $43,967, and for women it was $29,095.

That’s great news for women whose wages are below the national average, or whose households are larger than the national average. But it’s terrible news for those with above-average incomes, along with those who are unmarried or childless. And it’s also bad news for the men who today pay for the disproportionate share of Obamacare’s subsidies …

Importantly, this analysis looks at the price of health insurance for a single individual within a household, instead of family-based insurance. While this situation won’t apply to everyone, it may apply to an increasing number of Americans, because Obamacare’s employer mandate only requires companies to cover insurance for their workers, and not their workers’ families.

The bigger problem, of course, is what happens if the people who face higher costs under Obamacare drop out of the system and pay the fine instead. Such adverse selection would make premiums even less affordable, and require a greater outlay of taxpayer subsidies.

Lawmakers, on a bipartisan 76–31 vote shortly before 10 p.m., approved expanding Medicaid eligibility in 2014 to 320,000 adults making up to 133 percent of the poverty line. Nearly a half-million Michiganders could enroll by 2021 under the federal health care law, according to estimates from Republican Gov. Rick Snyder, who supports providing the government-funded health insurance to more people.

“I believe it’s time for us to stop playing defense with something that is the law of the land and begin to play offense,” said Rep. Mike Shirkey, R-Clark Lake, who was a staunch opponent of Medicaid expansion before changing his mind. “This is a very unique opportunity for us to negotiate from a position of strength to get reforms in what have been long-held entitlement reforms, real reforms that will help people and help taxpayers.”

The measure heads to the Senate, where passage could prove more difficult because the chamber is dominated by Republicans, 26–12, while GOP control of the House is narrower. Under legislative rules, the House had to vote this week if the Senate is to approve the bill before lawmakers break for the summer in a week.

“The majority leader has listed Medicaid reform as one of the issues he’s interested in taking a hard look at before the session is done and he intends to talk to his caucus about further action on Tuesday,” said Amber McCann, spokeswoman for Senate Majority Leader Randy Richardville, R-Monroe.

Medicaid covers roughly one in five Michigan residents – mainly low-income children, pregnant women and the disabled along with some poorer working adults.

Not waiting for formal gubernatorial approval, foes of her Medicaid expansion already are moving to undo at the ballot box and in court what they could not block at the Legislature.

Former state Sen. Frank Antenori said he is meeting with attorneys today to firm up the language for a referendum on key portions of the law.

He needs to get at least 86,405 signatures before Sept. 12 to hold up enactment of the expansion until voters get their say next year.

Antenori is not trying to block what amounts to a $240 million tax on hospitals designed to pay for the program. He conceded that provision is likely exempt from voter review and veto.

But that part of the package is not going to go unquestioned.

Christina Sandefur, an attorney with the Goldwater Institute, is reviewing whether that levy is a tax and not an “assessment” as Gov. Jan Brewer has contended.

If she believes it is a tax, that would make the levy illegal because it was not approved by a two-thirds margin as required by the Arizona Constitution. At that point, Sandefur said her organization is likely to sue to prohibit the state from collecting it.

That would effectively kill Medicaid expansion because there would be no money to leverage the $1.6 billion a year in federal aid.

The dual preparations are occurring as the Senate on Thursday approved the plan on an 18–11 margin. Five Republicans broke ranks to join with 13 Democrats.

Sen. Al Melvin, R-Tucson, said he is counting on the referendum Antenori is sponsoring with Ron Gould, another former state senator, to overturn the legislative action.

Aetna Inc. will stop selling health insurance to individual consumers in California at the end of the year, withdrawing as the federal health law is expected to reshape the market in 2014.

The pullout is likely to draw attention as California has become a focus of national debate over the law’s impact. Supporters, including President Barack Obama, who highlighted the state in a recent speech, argue that it has shown the success of the health overhaul in encouraging competition and pushing down prices.

Insurance-industry experts say similar moves by other carriers in other states may emerge in coming months, as companies with limited market share decide to avoid the uncertainty tied to the law’s changes.

Aetna said it currently has about 49,000 individual policyholders in California. In 2011, when it had substantially bigger membership, it was the fourth-biggest player in the state’s consumer market, with about 5.2% of the plans sold that year, according to a report from Citigroup Inc. C +1.16%

Aetna isn’t one of the 13 insurers participating in the state’s new consumer insurance marketplace set to launch this fall under the federal law. Like several other major national carriers, it has said it would join only a limited number of these exchanges. A carrier can still offer consumer plans without being in the exchange.

Aetna said it will continue selling health insurance in California to employers and Medicare beneficiaries, as well as dental and life-insurance products. The insurer said it is “fully committed to serving the needs of our 1.5 million members in the state.” A company spokeswoman declined to comment about the reasons for Aetna’s individual-business withdrawal. People who currently have Aetna individual health coverage will have to find plans with other carriers by year-end.

When the Patient Protection and Affordable Care Act (“Obamacare”) was being debated, proponents were accused of saddling Americans with inferior and expensive health care while keeping generous coverage for themselves at taxpayer expense. To rebut that allegation and build confidence in the bill, a provision was added mandating that members of Congress – and their staff members – get their coverage through the new exchange system the bill set up. Now that the time to sign up for exchange coverage is nearing, a Democratic member, Rep. John Larson (D., Conn.), is saying that “this is simply not fair” – as key staff members head for the exits to avoid Obamacare.

Politico reports that “many on Capitol Hill fear it could lead to a brain drain” and notes that “[t]he problem is far more acute in the House, where lawmakers and aides are generally younger and less wealthy.”

What? Obamacare disproportionally hurts those with lower incomes? It may come as a surprise, but it shouldn’t. We’ve known this since before the legislation even passed.

More to the point, why did Rep. Larson vote to impose on the country a health coverage system that “is simply not fair”?

Later this month, the House of Representatives could consider legislation regarding pediatric research. Legislation regarding this issue (H.R. 1724) was first introduced in April, and a new version of the bill (H.R. 2019) was introduced in May.

Although largely similar, H.R. 1724 would require the director of the National Institutes of Health (NIH) to provide a justification for any existing grants studying health economics, and would prohibit new grants until “a federal law has been enacted authorizing the National Institutes of Health to use funding specifically for health economics research.” Press reports indicate that H.R. 2019 excludes the restrictions included in H.R. 1724 “in order to please Democrats who favor the research.”

This is a mistake. The House should ensure that H.R. 1724’s proposed restrictions on health economics research remain in any NIH-related legislation that comes to the House floor. To do otherwise would provide tacit approval to Obamacare’s road to government-rationed health care.

The provision omitted from H.R. 2019 would have instituted an important and necessary protection on taxpayer-funded research on cost-effectiveness in health care. In recent years, the federal government has funded numerous such studies. For instance, a June 2011 Government Accountability Office report examining projects funded by the “stimulus” highlighted NIH grants studying the cost-effectiveness of various medical treatments …

Setting aside the wisdom of using taxpayer funds to examine the cost-effectiveness of various treatments, such research could eventually be used to deny patients access to certain kinds of care.

One of the chief ways that Obamacare seeks to expand insurance starting next year is by setting up government-run insurance exchanges in all 50 states on which private insurers will be able to sell government-designed insurance policies to individuals receiving government subsidies. Several weeks ago, there was a raging debate when California announced details on the plans to be offered on its state exchange. Much of the debate focused on whether the cost of the new plans was too high, especially for younger and healthier Californians. But another important element was that, as the Los Angeles Times reported, “one downside for many consumers will be far fewer doctors and hospitals to choose from.” One of the largest insurers in the state, Blue Shield of California, “said its exchange customers will be restricted to 36% of its regular physician network statewide.” In other words, many Californians who obtain insurance through the exchange could end up with a lot of restrictions to accessing health care.

The other major way that Obamacare expands coverage is by making millions more Americans eligible for Medicaid, the joint state/federal health insurance program for those with low-incomes. The problem is that Medicaid pays doctors significantly less than private insurance companies, and as things stand, an increasing number of doctors are refusing to see Medicaid patients. According to a 2012 survey by Jackson Healthcare, 58 percent of general physicians, or internists, say they cannot take on new Medicaid patients – and this is before next year’s expansion.

In order to pay for the roughly $1.8 trillion cost of the health care law’s coverage expansion, Democrats raised taxes and sought to extract savings from Medicare by reducing payments to hospitals and other providers of medical care, in hopes that it would prompt them to cut costs. Paul Spitalnic, the acting chief actuary of the Centers for Medicare and Medicaid Services, warned last month, that if fully implemented, the cuts would reduce Medicare payments rates “considerably below” even rock bottom Medicaid compensation levels. Spitalnic predicted that, “Congress would have to intervene to prevent the withdrawal of providers from the Medicare market and the severe problems with beneficiary access to care that would result.”

Defenders of government health care could argue, in response to this, that even if the worst predictions of Obamacare critics are realized and patient access is less than ideal, it would still be vastly better than a system in which they’re uninsured. However, this is operating under the mistaken assumption that Obamacare would only impact those receiving government assistance. In reality, when 30 million newly-insured Americans seek care in an already strained medical system without a corresponding spike in the number of doctors, even the currently insured may find it a lot more difficult to obtain care in a timely manner than they can currently. The same Jackson survey cited above projected “significant” attrition among American physicians in the coming years, with more than a third of doctors planning to leave medicine within a decade. The United States will not only need to replace these outgoing doctors, but will have to educate enough new doctors quickly enough to meet additional demand. With the health care law putting downward pressure on expected lifetime physician compensation, it’s unclear whether a critical mass of college graduates will go through the lengthy and costly training process required for them to become practicing physicians.